Substance Use in Pregnancy: Identifying Stigma and Improving Care

Andrea Weber,1 Benjamin Miskle,1 Alison Lynch,1 Stephan Arndt,2 Laura Acion3 1Department of Psychiatry, University of Iowa Health Care, Iowa City, IA, USA; 2Department of Biostatistics, University of Iowa, Iowa City, IA, USA; 3Universidad de Buenos Aires – CONICET, Instituto de Cálculo, Ciudad Autón...

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Autores principales:	Weber A, Miskle B, Lynch A, Arndt S, Acion L
Formato:	article
Lenguaje:	EN
Publicado:	Dove Medical Press 2021
Materias:	stigma pregnancy substance use opioid use harm reduction Public aspects of medicine RA1-1270
Acceso en línea:	https://doaj.org/article/91a36006691949118c7a86d160e24518
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spelling	oai:doaj.org-article:91a36006691949118c7a86d160e245182021-11-23T18:43:00ZSubstance Use in Pregnancy: Identifying Stigma and Improving Care1179-8467https://doaj.org/article/91a36006691949118c7a86d160e245182021-11-01T00:00:00Zhttps://www.dovepress.com/substance-use-in-pregnancy-identifying-stigma-and-improving-care-peer-reviewed-fulltext-article-SARhttps://doaj.org/toc/1179-8467Andrea Weber,1 Benjamin Miskle,1 Alison Lynch,1 Stephan Arndt,2 Laura Acion3 1Department of Psychiatry, University of Iowa Health Care, Iowa City, IA, USA; 2Department of Biostatistics, University of Iowa, Iowa City, IA, USA; 3Universidad de Buenos Aires – CONICET, Instituto de Cálculo, Ciudad Autónoma de Buenos Aires, ArgentinaCorrespondence: Andrea WeberDepartment of Psychiatry, University of Iowa Health Care, 500 Newton Road, Iowa City, IA, 52242, USATel +1 319-384-8014Fax +1 319-384-7467Email andrea-n-weber@uiowa.eduAbstract: This review examines the impact of stigma on pregnant people who use substances. Stigma towards people who use drugs is pervasive and negatively impacts the care of substance-using people by characterizing addiction as a weakness and fostering beliefs that undermine the personal resources needed to access treatment and recover from addiction, including self-efficacy, help seeking and belief that they deserve care. Stigma acts on multiple levels by blaming people for having a problem and then making it difficult for them to get help, but in spite of this, most pregnant people who use substances reduce or stop using when they learn they are pregnant. Language, beliefs about gender roles, and attitudes regarding fitness for parenting are social factors that can express and perpetuate stigma while facilitating punitive rather than therapeutic approaches. Because of stigmatizing attitudes that a person who uses substances is unfit to parent, pregnant people who use substances are at heightened risk of being screened for substance use, referred to child welfare services, and having their parental rights taken away; these outcomes are even more likely for people of color. Various treatment options can successfully support recovery in substance-using pregnant populations, but treatment is underutilized in all populations including pregnant people, and more knowledge is needed on how to sustain engagement in treatment and recovery activities. To combat stigma when working with substance-using pregnant people throughout the peripartum period, caregivers should utilize a trauma-informed approach that incorporates harm reduction and motivational interviewing with a focus on building trust, enhancing self-efficacy, and strengthening the personal skills and resources needed to optimize health of the parent-baby dyad.Keywords: stigma, pregnancy, substance use, opioid use, harm reductionWeber AMiskle BLynch AArndt SAcion LDove Medical Pressarticlestigmapregnancysubstance useopioid useharm reductionPublic aspects of medicineRA1-1270ENSubstance Abuse and Rehabilitation, Vol Volume 12, Pp 105-121 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	stigma pregnancy substance use opioid use harm reduction Public aspects of medicine RA1-1270
spellingShingle	stigma pregnancy substance use opioid use harm reduction Public aspects of medicine RA1-1270 Weber A Miskle B Lynch A Arndt S Acion L Substance Use in Pregnancy: Identifying Stigma and Improving Care
description	Andrea Weber,1 Benjamin Miskle,1 Alison Lynch,1 Stephan Arndt,2 Laura Acion3 1Department of Psychiatry, University of Iowa Health Care, Iowa City, IA, USA; 2Department of Biostatistics, University of Iowa, Iowa City, IA, USA; 3Universidad de Buenos Aires – CONICET, Instituto de Cálculo, Ciudad Autónoma de Buenos Aires, ArgentinaCorrespondence: Andrea WeberDepartment of Psychiatry, University of Iowa Health Care, 500 Newton Road, Iowa City, IA, 52242, USATel +1 319-384-8014Fax +1 319-384-7467Email andrea-n-weber@uiowa.eduAbstract: This review examines the impact of stigma on pregnant people who use substances. Stigma towards people who use drugs is pervasive and negatively impacts the care of substance-using people by characterizing addiction as a weakness and fostering beliefs that undermine the personal resources needed to access treatment and recover from addiction, including self-efficacy, help seeking and belief that they deserve care. Stigma acts on multiple levels by blaming people for having a problem and then making it difficult for them to get help, but in spite of this, most pregnant people who use substances reduce or stop using when they learn they are pregnant. Language, beliefs about gender roles, and attitudes regarding fitness for parenting are social factors that can express and perpetuate stigma while facilitating punitive rather than therapeutic approaches. Because of stigmatizing attitudes that a person who uses substances is unfit to parent, pregnant people who use substances are at heightened risk of being screened for substance use, referred to child welfare services, and having their parental rights taken away; these outcomes are even more likely for people of color. Various treatment options can successfully support recovery in substance-using pregnant populations, but treatment is underutilized in all populations including pregnant people, and more knowledge is needed on how to sustain engagement in treatment and recovery activities. To combat stigma when working with substance-using pregnant people throughout the peripartum period, caregivers should utilize a trauma-informed approach that incorporates harm reduction and motivational interviewing with a focus on building trust, enhancing self-efficacy, and strengthening the personal skills and resources needed to optimize health of the parent-baby dyad.Keywords: stigma, pregnancy, substance use, opioid use, harm reduction
format	article
author	Weber A Miskle B Lynch A Arndt S Acion L
author_facet	Weber A Miskle B Lynch A Arndt S Acion L
author_sort	Weber A
title	Substance Use in Pregnancy: Identifying Stigma and Improving Care
title_short	Substance Use in Pregnancy: Identifying Stigma and Improving Care
title_full	Substance Use in Pregnancy: Identifying Stigma and Improving Care
title_fullStr	Substance Use in Pregnancy: Identifying Stigma and Improving Care
title_full_unstemmed	Substance Use in Pregnancy: Identifying Stigma and Improving Care
title_sort	substance use in pregnancy: identifying stigma and improving care
publisher	Dove Medical Press
publishDate	2021
url	https://doaj.org/article/91a36006691949118c7a86d160e24518
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Substance Use in Pregnancy: Identifying Stigma and Improving Care

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